Little is known about substance abuse treatment within problem-solving courts, including treatment-related policies and the treatment decision-making processes. To examine opioid dependence treatment in the context of problemsolving courts, the author conducted semi-structured qualitative interviews with judges of 20 problem-solving courts (drug and veterans courts) and one prison-based treatment program in Indiana between 2015 and 2016. Interview topics included the frequency of opioid abuse among participants, the treatment decision-making process, relationships between the court and outside treatment providers, court treatment team members, treatment requirements for graduation, judges’ information sources about treatment methods, cost and access issues, and policies and attitudes relating to counseling, self-help groups, residential treatment, and medication-assisted treatment. Results included the following policies and practices, some of which are troubling in light of evidence-based recommendations from professional health organizations. Counseling and self-help groups are almost always required for participants, but counseling is considered more central to treatment. Nonspiritual self-help groups are limited and largely inaccessible, potentially posing constitutional problems for courts that mandate self-help group attendance. Medication-assisted treatment (MAT) for opioid addiction is ideologically contested in problem-solving courts, despite strong evidence of its effectiveness. Court treatment decisions are made by treatment teams that consist of mental health counselors, judges, law enforcement, probation officers, prosecutors, and attorneys, but rarely include physicians. Treatment through veterans’ courts tends to be more accessible, less costly, and more inclusive of MAT than treatment through drug courts. Finally, a significant minority of court treatment teams make medication-related decisions contrary to best medical practices, such as requiring patients to wean off of MAT without a physician’s input. The Article suggests that states should increase funding to problem-solving courts in order to decrease treatment costs for low-income participants, increase training opportunities for court treatment teams regarding medication-assisted treatment, and fund physician participation on court treatment teams. Additionally, based on concerns expressed by judges, increased funding is recommended for residential treatment centers, halfway houses, and transportation for court participants.